Every day, people all throughout Afghanistan face not only the public health challenges of the COVID-19 pandemic but also a lack of accessibility to food, employment and a sense of stability. A study by Jean-Francois Trani and Washington University in St. Louis discussed how challenges like these may lead to both increased poverty and increased disability. They also identified how disability and poverty may overlap or compound the suffering of individuals. Here is some information about the link between disability and poverty in Afghanistan.
Challenges for Children in Afghanistan
In an environment with varying challenges, illness, injury, neglect and malnourishment can lead to lifelong health concerns and disability for children. Likewise, the chronic stress of struggling to sustain the life of a family in the midst of violence and trauma may also lead to debilitating psychiatric conditions like post-traumatic stress disorder. This is the crisis of disability and poverty in Afghanistan.
Mothers and grandmothers like Haji Rizva (only identified by the first name for her safety), struggle to feed their children. She thinks specifically of her 18-month-old granddaughter, Parvana, who had been constantly vomiting and too weak to move for days. “We didn’t have enough to feed her,” Haji Rizva told NPR while waiting in the ward for malnourished children at Indira Gandhi Children’s Hospital in Kabul, Afghanistan. “Sometimes we only have tea for two, three days. We don’t even have bread.”
Around the same time, and in the same city, fathers like Kahn Wali Kamran told the Associated Press that they fear finding their young children dead when they return home from work each day. With a surge in large bombings, targeted killings and other forms of crime (including armed robbery and kidnapping for ransom), the future appears increasingly dangerous and uncertain.
The Link Between Disability and Poverty in Afghanistan
The Asia Foundation studies suggest that 17% of Afghan citizens suffer from some form of disability and 8.9% have severe impairments and are dependent on others. Additionally, after decades of uninterrupted conflict, the Office for the Coordination of Human Affairs (OCHA) noted that despite the lack of comprehensive study and measurement of mental health in such a volatile region, it conservatively estimated that more than half of the population suffers from some form of depression, anxiety or post-traumatic stress disorder.
Halfway across the world, Trani’s 2012 study examining the links between poverty and disability using data from Afghanistan and Zambia has become relevant once again. The study noted that it is logical that disabled individuals may be more likely to be poor, as they have a higher cost of living, and a diminished ability to perform certain tasks, especially those they may require for employment. People with PTSD may be unable to complete tasks, communicate effectively and stay calm, making it harder to acquire and maintain employment. However, poverty and disability as concepts are difficult to define, as they both take many dimensions into consideration.
Generally, the amount of income a household earns determines poverty status, and what necessary commodities that the family in that household would be able to acquire. However, because all households have different needs and expenses, this is an unreliable measurement. Instead, the capability to live in a state of well-being, and have a reasonable life expectancy, quality nourishment and shelter, basic education and access to health care should be factors when considering poverty. Trani noted that low income is a cause of poverty, not the definition of poverty. In this way, violence, too, is a cause of poverty, and so is disability.
This creates an unforgiving cycle that allows both poverty and disability to increase in prevalence. When a person is in poverty, like Kamran or Haji Rizva, they are unable to provide basic necessities for themselves and their families. Without proper shelter and protection, Kamran’s children are more likely to suffer severe injury, potentially leading to lifelong physical disability. Likewise, without proper nutrition, Parvana and other kids like her are less likely to grow and develop properly leading to weakened muscles, bones and organ systems. Poverty, in this case, causes injury. Injury then causes disability. This lowers employment opportunities, causing disabled individuals to fall further into poverty, putting them at greater risk of traumatic stress, further injury and other sufferings. This is the cycle of poverty and disability that has captured Afghanistan for decades.
The Humanitarian Response Plan for Afghanistan
Fortunately, OCHA has recently updated its ongoing Humanitarian Response Plan for Afghanistan to take greater action to help marginalized groups through the violence and the pandemic.
“Given the scale of vulnerability in Afghanistan, this effort will be guided by a range of both new and well-established technical working groups focused on gender, disability inclusion, gender-based violence (GBV), child protection, accountability to affected people (AAP) and protection from sexual exploitation and abuse (PSEA)” wrote Parvathy Ramaswani in the plan’s updated introduction.
The efforts in regards to the pandemic will be largely consistent with others around the world, introducing sanitation protocols and vaccine distribution to the best of their ability, as reducing the spread of the pandemic will naturally provide relief to people caught in the poverty-disability cycle. As in developed countries, people with preexisting conditions are much more likely to develop complications from COVID-19 like pneumonia, infection and organ system failure. This could affect various disabilities that people develop from genetic conditions, malnutrition, previous infections and other injuries. Physical disability is quite prevalent in Afghanistan, so complications and deaths are also a greater concern than in some other areas.
From a psychiatric disability standpoint, the response plan is more targeted, directing resources and funding to local hospitals and clinics to seek out trauma patients who have not received adequate treatment prior to 2021. “With the volatile security situation creating higher trauma needs and associated disabilities, secondary trauma care continues to be a critical need,” the report noted. OCHA will continue to monitor the mental health of citizens closely through 2021, trying to care for those it missed in previous psychiatric treatment initiatives.
Help is on the way for people like Haji Rizva and Kamran, to prevent them and their children from developing new health concerns or complications from COVID-19. The OCHA response plan aims to reach 86% or more of the existing disabled population in Afghanistan.
– Anika Ledina